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Apical LV lead positioning during CRT should be avoided
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Heart Rhythm Society 31st Annual Scientific Sessions
DENVER — Left ventricular leads positioned in the apical region were associated with significantly increased risk for HF among patients who underwent cardiac resynchronization therapy compared with leads positioned in the mid-ventricular or basal regions, according to a speaker here today.
Jagmeet P. Singh, MD, PhD, of the Massachusetts General Hospital in Boston, presented data from a substudy of the MADIT-CRT trial. The trial was conducted to evaluate the effect of LV lead location on the outcomes of 799 patients who were randomly assigned to the CRT-D device arm of the study. Patient lead positions were as follows: mid-ventricular (n=506); basal (n=183); and apical (n=110).
Findings from an average 29-month follow-up period indicated that cardiac resynchronization therapy (CRT) benefits were similar for patients with leads in the anterior, lateral or posterior positions (P=.629). However, 22% of patients who had leads positioned apically had an increased risk for HF and mortality compared with an average of 12% among patients who had leads positioned in the mid-ventricular or basal position (P=.027).
Additionally, after adjusting for sex, left branch bundle block and ischemic cardiomyopathy, the researchers determined that apical lead location was associated with an increased risk for HF and death compared with the basal or mid-ventricular region (HR=1.64; CI, 1.05-2.58) and an increased risk for death (HR=2.59; CI, 1.28-5.25).
“The results of this MADIT-CRT substudy are a major step forward towards understanding the impact of LV lead implantation on CRT response and clinical outcomes,” Singh said. He added that looking back at previous patient groups who have not positively responded to CRT may help determine alternate lead positions.
“These findings could also enhance the overall response rate to CRT for future patients by simply avoiding the apical position altogether,” Singh said. – by Nicole Blazek
Studies like this are good because they provide data about the major benefit of CRT. The apical position being less satisfactory than lateral or posterior positions has been established previously by other investigators, but it’s nice to see it in another study. I think we now know that it’s necessary to stay out of the apex for left ventricular pacing and CRT, and the other positions certainly look good.
– Douglas L. Zipes, MD
Cardiology
Today Section Editor
For more information:
- Sing JP. LBCTI. Presented at: Rhythm Society 31st Annual Scientific Sessions 2010; May 12-15, 2010; Denver.
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